Federal data: Pocono Medical Center among cheaper places to get sick

Paramedics wheel a patient whose heart is failing through the doors at Pocono Medical Center, trailed by a distraught family member.

JENNA EBERSOLE

Paramedics wheel a patient whose heart is failing through the doors at Pocono Medical Center, trailed by a distraught family member.

At a different regional hospital, the scenario also unfolds. But by the end of the patient's stay, charges for care could be thousands of dollars higher.

The variation is playing out across the country, according to data released by the Centers for Medicare and Medicaid Services.

The average cost of care for the same inpatient medical issue often differs by tens of thousands of dollars.

The federal data inventory the top 100 most common inpatient conditions for Medicare patients in fiscal year 2011. It includes the amount the hospital charged on average per patient, and the amount Medicare paid the hospital in return.

Hospital officials urged caution with the data, which does not take into account different hospital charge structures and the range of specialists and quality of care.

But a Pocono Record analysis found that Pocono Medical Center charged less in most of the categories compared to St. Luke's Hospital in Bethlehem, Lehigh Valley Hospital and Geisinger Medical Center.

Geisinger Wyoming Valley Medical Center aligned more closely with PMC. But in the top 10 most common conditions, PMC's price was lower every time.

The data are not a perfect comparison for every patient, as it only includes Medicare patients. Insurance companies negotiate costs with medical providers to determine what they actually pay for procedures.

Still, the data illustrate how much cost difference can exist between services at hospitals even within the same geographic region.

The sticker price for the conditions is rarely what patients see after negotiations with insurance companies and Medicare payment is complete. But for patients who are uninsured or have high deductibles, the data provide a glimpse into the variation they face, officials said.

CMS spokeswoman Kathryn Ceja said the data are a step toward transparency and accountability.

"We would like consumers to be able to have control of their health care," she said.

But hospital spokespeople said the data do not capture real differences among hospitals.

Geisinger spokeswoman Wendy Wilson said the Danville location is a Level 1 trauma and teaching facility and receives higher payment from Medicare for training new physicians.

The Danville location also often sees the sickest patients with the most complex problems, she said, and the hospital provides a variety of high-level, specialty and expensive care and services.

Patients without insurance often qualify for uncompensated care, meaning that Geisinger absorbs charges as a nonprofit.

Lehigh Valley spokesman Brian Downs also said the charges reflect costs for services. They are based on utilization, and patients may have multiple health issues.

"You have to keep in mind that each patient is different and their care is different," he said.

But the hospital supports transparency in pricing, he said, and actual Medicare reimbursements are often lower than at other hospitals.

PMC spokesman Geoffrey Roche agreed that reimbursements are almost always lower than charges, and each hospital's mission and services must be taken into account.

But the data released by Health and Human Services Secretary Kathleen Sebelius goes further than before in allowing people to compare costs.

Ceja said the actual differences in quality must be brought to light so patients can make informed decisions about their care.

"What are you getting for what you're paying?" she said. "If something is better quality or you want to charge more because it's quality, then wonderful. But people have to have a clear connection between what they're paying and the quality of the services that they're getting."